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[Resection arthoplasty of the trapezium with ligament reconstruction and tendon interposition and variations]
Martin Franz Langer1, Jörg Gerhard Grünert2, Frank Unglaub3
1Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland. langer.martin@ukmuenster.de.
Objective:
Creation of a pain-free, flexible and stable (pseudo) joint between the carpus and the base of the 1st metacarpal bone.
Indications:
Painful carpometacarpal (CMC)‑I joint due to primary or secondary osteoarthritis, CMC‑I instability.
Contraindications:
Carpal instability, local infection, tumors.
Surgical Technique:
Resection of the trapezium (and of the arthritic joint surfaces in CMC‑I and STT [scaphoid-trapezium-trapezoid-joint]), stabilization of the base of the 1st metacarpal bone by suspension with a distally pedicled strip of the flexor carpi radialis tendon or variants thereof.
Postoperative Management:
Immobilization in a splint for 3-5 weeks, followed by hand therapy.
Results:
Worldwide for almost 40 years, regardless of the exact technique, almost always (90%) significant pain reduction, increased strength in the grip and slightly less in the pinch grip, very good mobility, 85-95% very satisfied patients and very good long-term results.
