Fifth carpometacarpal arthritis management: A comparative cadaver study of two arthrodesis methods

Osteoarthritis of the fifth carpometacarpal (CMC) joint is an uncommon yet challenging complication following fracture-dislocation injuries. This condition results in chronic pain, restricted motion, and impaired hand function, significantly limiting the patient's ability to perform daily activities. Surgical interventions for post-traumatic osteoarthritis of the fifth CMC joint include arthrodesis and arthroplasty, with the Dubert technique combining elements of both approaches. This study aimed to compare the effects of Dubert arthrodesis and traditional fifth metacarpal (MC)-hamate arthrodesis on the flexion-extension range of motion of the fifth MC. An in vitro study was conducted using twelve cadaveric forearm specimens. The specimens were divided into two groups: Group 1 underwent Dubert arthrodesis, and Group 2 underwent fifth MC-hamate arthrodesis. Preoperative and postoperative evaluations were performed using computed tomography (CT) scans to measure the flexion-extension range of motion of the fifth MC. Twelve specimens, with a mean age of 53 years (range: 41-60 years), were analyzed. No significant difference in preoperative flexion-extension motion was observed between the groups. Both groups exhibited a significant reduction in flexion-extension motion following arthrodesis. However, no significant difference in postoperative flexion-extension motion was observed between the groups. Neither Dubert arthrodesis nor fifth MC-hamate arthrodesis preserved the physiological flexion-extension motion of the fifth MC. Biomechanical analysis showed no significant advantage of one technique over the other. The Dubert arthrodesis procedure was technically demanding, with inadequate resection potentially leading to residual symptoms. Further comparative clinical studies are required to confirm these findings and determine the optimal surgical approach for managing fifth MC arthritis.