A Comparison of Minimally Invasive and Conventional Techniques for Stabilisation of the Carpometacarpal Joint of the Thumb after Dislocation or Subluxation
Zhemin Zhang, MD1; Xu Zhang, MD2; Yadong Yu, MD1; (1)Third Hospital of Hebei Medical University, Shijiazhuang, China, (2)Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
Introduction: To introduce a minimally invasive surgical technique for stabilisation of the carpometacarpal joint (CMCJ) of the thumb after dislocation or subluxation. In addition, to perform a prospective study to compare the novel mini-open technique with the conventional open technique.
Materials & Methods: From February 2013 to May 2017, patients were allocated randomly into group A (n = 32) and B (n = 27). The mean time interval between injury and ligament reconstruction was 12 days (5 to 40). Patients in group A were treated with minimally invasive technique through two 1.5 cm incisions parallel to the thumb metacarpal over the radial and dorsoulnar aspects of the CMCJ of the thumb. Under fluoroscopic control two 1 mm guide wires were inserted into the base of the thumb metacarpal and trapezium, respectively, and then were over drilled to create two 3.5 mm channels. The radial half of the flexor carpi radialis was mobilised to the wrist through two short transverse incisions to emerge at the level of the trapezium. A 28-gauge stainless steel wire loop was placed through the channels for passage of the tendon graft to form a figure-of-eight pattern over the volar aspect of the CMCJ. The rest of the graft was further passed around itself at the radial aspect of the trapezium. Patients in group B were treated via an 8 cm S-shaped incision by leading the flexor carpi radialis tendon graft beneath the ligaments and the abductor pollicis longus insertion, through a tunnel drilled in the metacarpal base, around the insertion of the flexor carpi radialis tendon and finally back to the dorsum of the base of the metacarpal. Significance was set at p<0.05.
Results: There were no skin problems or infection in both groups. At the final follow-up of 2 years, stability of the CMCJ of the thumb had been achieved in all patients. In comparison, there were significant differences in total palmar abduction, radial abduction, arc of movement, Smith and Cooney score, scar pain, appearance, and patients satisfaction (p<0.05), and no significant difference in opposition of the thumb, pinch, or grip strengths of the hand (p>0.05).
Conclusions: The minimally invasive technique is reliable for stabilisation of thumb CMCJ the thumb after dislocation or subluxation, resulting in better function and appearance of scars.
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