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The Role of First Metacarpal Osteotomy in the Management of Basilar Thumb Arthritis
Megan Anne Conti Mica, MD; O'Shaughnessy Maureen, MD; Rizzo Marco, MD
Mayo Clinic, Rochester, MN

Introduction: Basilar thumb arthritis is a common and disabling condition. Surgical treatment include arthroplasty, trapeziectomy, arthroscopic resection and arthrodesis. First metacarpal extension (Wilson) osteotomy has been described for both early and late stage arthritis. Current literature does not adequately demonstrate the spectrum of utilization of osteotomy, particularly in late stage arthritis. This study reviews the long term outcomes of osteotomy in both early and late stage CMC arthritis.

Methods: An IRB approved retrospective study was performed over a 26 year period of patients undergoing first metacarpal osteotomy. At latest follow up, data including range of motion, grip strength, complications, need for subsequent surgery and progression of arthritis were recorded.

Results: The series includes 10 patients (10 female) with an average age at surgery of 48 (range 25-63). Average follow up was 36 months (range 3-90). The main diagnoses in this series were early degenerative changes of the CMC joint with painful subluxation or instability and adduction contracture with weakness and deformity. For early degenerative changes, average postoperative radial abduction was 49 (range 40-70) degrees and palmar abduction 43 (range 30-70) degrees on the affected extremity (101% and 89% of the contralateral) and average oppositional pinch strength of 95% (range 63-117%), appositional pinch strength 92% (range 70-127%) and grip strength was 82% (range 71-87%) of unaffected extremity. For late adduction deformity the average postoperative radial abduction was 39 (range 15-62) degrees and palmar abduction 35 (range 15-55) degrees on the affected extremity (67% and 60% of the contralateral) and average oppositional pinch strength of 42% (range 40-43%), appositional pinch strength 44% (range 33-55%) and grip strength was 75% (range 72-78%) of unaffected extremity. (Table 1) Three patients required secondary surgery for symptomatic hardware. All patients in the series had satisfactory outcomes and did not require revision procedures for pain or instability at average follow up of 36 months (range 3-90).

Discussion and Conclusion: Metacarpal osteotomy is a reliable motion preserving procedure for patients with early CMC arthrosis and instability that did not show progression of disease while decreasing pain, increasing pinch and grip strength. Later stages of arthritis with painless adduction contractures were noted to have increased pinch strength and better palmar and radial abduction. (Figure 1) No patients in this series required additional procedures for their CMC arthritis. The significance of these results better enable surgeons to utilize metacarpal osteotomy in managing both early and late CMC arthritis

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