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Prevalence and Predictors of Second Metacarpal Fracture After Suture Button Suspension for 1st CMC Arthritis
Ajul Shah, MD; Robin Wu, BS; Rajendra Sawh, MD; Carmella Fernandez, MD; Grant Thomson
Yale University School of Medicine, New Haven, CT

Introduction: A relatively new method to treat 1st CMC arthritis is suture button suspensionplasty. A potential complication for this procedure is second metacarpal fracture. In this study, we perform a retrospective analysis to determine the potential factors that may lead to fracture. We hypothesize that the angle of suspension, the placement of the suture button on the index metacarpal, and the use of the 2.7 mm overdrill directly correlate to the presence of metacarpal fracture.

Methods: A retrospective chart review was performed from 2011-2015. Demographic factors, length of follow up, presence of fracture, previous and simultaneous procedures, and use of the overdrill were recorded. Radiographic analysis included the angle of suspension and the ratio of suture button height to the height of the index metacarpal. Statistical analyses were performed.

Results: 51 patients underwent suture-button suspension. All patients underwent simultaneous trapeziectomy. All patients were immobilized for 10-14 days in a thumb spica splint prior to start of physical therapy. The average length of follow up was 9 months. 19 patients had simultaneous procedures, and 15 patients had previous ipsilateral hand procedures. The 2.7 mm overdrill was used in 39 patients, and the tapered 1.1 mm K wire was used in 12 patients. 4 patients suffered index metacarpal fracture (7.8%). There were no statistical differences in the angle of suspension (42.35 degrees non-fracture group vs 40 degrees fracture group, p = 0.76), the ratio of suture button height to second metacarpal height (0.41 non-fracture group vs 0.38 fracture group p = 0.67), or the use of the overdrill (79% overdrill in non-fracture group vs 50% overdrill in fracture group).

Conclusion: Second metacarpal fracture after suture button suspension is a concerning complication. Our study demonstrates that this complication may be more prevalent than originally thought, and demonstrates that fracture is not related to the angle of suspension or the location of the index metacarpal suture button. It demonstrates that fracture can occur even in the absence of the 2.7 mm overdrill. This leads credence to alternative theories for the mechanism of fracture, namely that the fiberwire may cause osteolysis of the bone and increase the propensity for eventual fracture. The sample size is small, and therefore, further long term follow up is necessary to determine if this pattern of fracture continues; if so, discussions must be held with regards to the acceptability of this complication.

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