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Basal Thumb Stabilization Using Percutaneous Suture Button Fixation: Technique and Outcome
Andrew K. Lee, MD; Mark Khorsandi, DO; American Total Orthopedics/Brown Hand Center
American Total Orthopedics/Brown Hand Center, Houston, TX, USA

Introduction

CMC Cable Fix (Instratek, Houston Texas) is an inter-metacarpal anchoring suture button suspension system that recreates the primary stabilizers of the basal thumb. The purposes of this study are to present a percutaneous technique utilizing this device and to evaluate whether this minimally invasive procedure can reduce operative time, facilitate earlier return to activities and produce outcome scores that are comparable to the traditional ligamentous reconstruction (LRTI) techniques.

Materials and Methods

A prospective study is currently being conducted on patients with various stages of basal thumb arthritis who are being treated with the CMC Cable Fix with or without trapeziectomies. Patients were asked to rate their preoperative and postoperative condition and functional capabilities using the validated DASH Scoring Protocol and Basal Joint Arthritis Outcome Survey. Additionally, all patients were evaluated for preoperative and postoperative grip and pinch strengths, operative time, time to return to previous activities and radiographic evaluations.

Results

Currently, there are 17 patients included in the study with an average follow-up of 5.2 months. Our early follow-up outcome score evaluation showed significant average DASH score improvement of 12 points at 8 weeks and 32 points at 12 weeks. The grip and pinch strengths improved an average of 15% and 12 % at 12 weeks, respectively. No significant subsidence of the 1stmetacarpals was noted at 12 weeks. The average additional operative time was 11.2 minutes. 33% of the patients returned to previous activity level by 8 weeks and 53% by 12 weeks. Additional follow-up and further comparative analysis with various LRTI procedures are planned.

Conclusion

Minimally invasive CMC Cable Fix procedure may accomplish improved outcomes by achieving anatomical correction of basal thumb instability without the complex procedures and potential complications of traditional LRTI. This may reduce, operative time, morbidity and facilitate a quicker recovery compared to the traditional basal thumb ligamentous reconstruction techniques.


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