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Long Term Outcomes of Wilson Osteotomy for Thumb Carpometacarpal Arthritis
Eric J. Yakish, MD; Abdo Bachoura, MD; John Lubahn, MD
UPMC Hamot, Erie, PA

Purpose: An abduction wedge osteotomy at the base of the thumb metacarpal, as described by Wilson, can be an effective treatment option, especially for younger patients with early carpometacarpal (CMC) arthritis, who fail to respond to conservative management. The purpose of this study was to evaluate the long-term survival and outcomes in patients who had previously undergone a metacarpal osteotomy for CMC arthritis of the thumb.
Methods: This was a retrospective case series. We identified 24 patients who had undergone thumb metacarpal osteotomy at least 10 years previous to initiating our study. A 5mm wedge osteotomy was performed and secured with k-wires outside the skin. Exclusion criteria included: pregnancy, surgeries performed on the thumb outside of the primary surgeonís practice, post-traumatic arthritis, inability to complete the questionnaire, osteotomy done for web space contracture. Participants in the study were asked to return for a clinical evaluation and underwent x-rays of the hand, maximum grip and key pinch strength testing and submitted responses to PRHWE and Quick-DASH questionnaires. Complications were noted.
Results: Of the 24 patients identified, 21 met inclusion criteria. Mean age at surgery was 41.5 years, (range, 19-54), n=22 patients. There were 8 males and 13 females. Two patients (3 cases) subsequently underwent basal joint arthroplasty. Mean time since surgery for patients that have not undergone additional CMC-related surgery is 12 years, (range, 10.5-13.3), n=22. Records reviewed showed 6 patients with perioperative complications, including pin site infections (5) and 1 with a fibrous non-union. Three patients were available for complete follow-up and demonstrated a mean PRWHE score of 34.8, QuickDASH score of 28.8, 89% pinch and 93% grip of the contralateral side respectively. One patient progressed from Eaton Stage II to Eaton Stage IV, while two remained at Stage II.
Conclusions: Our preliminary results indicate that abduction wedge osteotomy appears to be a durable option in surgical management of early thumb CMC arthritis, assuming that our patients have not sought care elsewhere. The majority of patients have not required any additional surgery for over 10 years. A relatively high infection rate can be attributed to protruding k-wires, which are a modifiable part of the procedure. Results are widely variable with respect to the 3 respondents at this point in the study. We are continuing to contact patients for follow-up at this point in the study with the hope to attain a larger number of respondents.

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