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Hybrid Fixation With a Low-Profile Locking Plate and Cannulated Compression Screw for Thumb Carpometacarpal
Kiyeon Um1, Su A Jo, Sang Ki Lee
1Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.
Introduction:
Thumb carpometacarpal (CMC) fusion offers durable pain relief and enhanced pinch stability for patients with advanced CMC arthritis. However, concerns regarding nonunion have hindered its widespread adoption. Hybrid fixation using an anatomically contoured low-profile locking plate and a cannulated compression screw (CCS) is intended to combine direct interfragmentary compression with angular and rotational stability; however, clinical evidence regarding this construct remains limited. This study aimed to evaluate the radiographic and functional outcomes of this hybrid construct.
Methods:
We retrospectively reviewed 35 patients who had undergone thumb CMC fusion using a precontoured biocompatible low-profile locking plate supplemented with a 3.0 mm CCS. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at 1, 3, 6, and 12 months to assess the radiographic palmar abduction angle, radiographic radial abduction angle, union status, and progression of scaphotrapeziotrapezoid arthritis. Clinical outcomes were measured using the visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and key pinch strength.
Results:
Radiographic union was documented in 32 patients (91.4%) at the scheduled 3-month visit and in all 35 patients (100%) at the scheduled 6-month visit, with no patient requiring revision surgery. Postoperative alignment was maintained without significant interval changes (P>0.05). VAS scores significantly improved by 3 months (P<0.001) and continued to improve through 12 months. Both grip and key pinch strength progressively increased, reaching significance by 6 months (P<0.05). QuickDASH scores demonstrated significant improvement beginning at 6 months (P<0.001). Three patients (8.6%) experienced minor hardware irritation, which was managed conservatively. No major complications occurred.
Conclusions:
Hybrid fixation using a low-profile locking plate and CCS was associated with union documented in all patients at the scheduled 6-month follow-up and improvements in pain and functional outcomes. Further comparative studies are needed to determine its relative benefits over other fixation methods.
