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Suture Button Suspensionplasty with Trapeziectomy: A Retrospective Analysis Utilizing a Novel Staging System for Proximal Migration
Sarah E. Rizzo, BS1; John Safanda, MD2
1Rosalind Franklin University of Medicine and Science, North Chicago, IL; 2Foundation Hospital, Kaiser Permanente, San Rafael, CA

Introduction: The purpose of this study is to retrospectively review the results of a technique for suture button suspensionplasty with full trapeziectomy utilizing a novel staging system for proximal migration. Traditional post-operative measuring systems, which measure the space between the metacarpal base and the scaphoid do not adequately account for arthritic changes and osteophyte formation, position of the metacarpal, or adduction contractures. Our goal was to create a postoperative staging system, which would be consistent irrespective of the degree of osteoarthritic changes or adduction contractures (Figure 1).
Materials & Methods: We evaluated 100 patients who received suture button suspensionplasty and full trapeziectomy with follow-up ranging from 1-2 years. We performed a radiographic analysis of proximal migration according to a novel staging system and measurement of abduction angle pre- and post-operatively.
Results: This staging system yielded excellent intraobserver and interobserver reproducibility. We found that 49 of the 50 control X-rays reviewed revealed that the thumb marker rested within stage 0. We demonstrated that 98% of our patients maintained a proximal migration stage of 0 or 1 (Figure 1 and 2). We also showed a statistically significant improvement in post-operative abduction angle (Figure 3).
Conclusions: Preliminary results of this staging system are favorable, but long-term follow-up studies are warranted. Our results indicate that this staging system is reliable and an improvement upon earlier methods for evaluating the degree of proximal migration pre- and post-operatively. We encourage this staging system to be utilized by other hand surgeons when deciding whether to operate on CMC arthritis of the thumb and/or to evaluate the success of the suspensionplasty.

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