Union Rates and Complications after Thumb Metacarpophalangeal Fusion
Kevin Lutsky, MD1; Jonas Matzon, MD2; David Edelman, MS3; Cory Lebowitz, DO4; Pedro Beredjiklian, MD2; (1)Thomas Jefferson University, Philadelphia, PA, (2)Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, (3)Thomas Jefferson, Philadelphia, PA, (4)Rowan University, philadelphia, PA
Purpose: Fusion of the thumb metacarpophalangeal joint (MPJ) can be performed using tension band wires (TBW) or plates and screws (PS). This study is to evaluate the results and complications using these techniques.
Methods: A retrospective review of patients who underwent thumb MPJ fusion at our institution from 2010-2016 was performed. Patients with >1 year follow-up were included. Data was collected including demographic information, indication for fusion, time to fusion, and complications. Final radiographs were examined and alignment measured.
Results: There were 56 thumbs in 53 patients (42 women and 11 men). There were 12 TBW and 44 PS. The mean age was 60.9 years (range: 18-77). The mean follow-up was 32.4 months (range: 12-86 months). Twenty-eight of 44 plates were non-locking and 16 were locking. Of the locking plates 7/26 used all locking screws and 9/26 had a combination of locked and non-locked screws. The mean flexion angle for TBW was 16.5° and for PS was 12.8°. The mean coronal angle for patients with TBW was 4.0° ulnar and PS was 2.5° ulnar.
The overall union rate was 95%. There were 12 complications (21%). Nine of these were in the PS group (3 nonunion, 3 delayed union, 1 infection, 1 CRPS, and 1 pain). The TBW complications (n=3) were painful hardware requiring removal. Eight complications (89%) in the PS group occurred in patients with locked plates. Five (83%) of the delayed or non-unions occurred in patients with locked plates and 4 of these (80%) were in plates with all screws locked.
Conclusion: Complications using PS or TBW are not infrequent. Alignment with both techniques is similar, but the use of locked plates specifically increases the rate of delayed or non-unions. We do not recommend the routine use of locked plates for fusion of the thumb MPJ.
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