Trapeziometacarpal Arthrodesis Technique and Outcomes using a Nitinol Compression Staple.

Abstract

Trapeziometacarpal (TMC) arthrodesis is a reliable procedure to treat individuals with trapeziometacarpal osteoarthritis (TMC OA) who have failed conservative treatment. Arthrodesis has classically been deemed as a suitable treatment for young, active males, particularly in the post-traumatic setting, who desire maximum strength. There are numerous arthrodesis techniques described in the literature, however, reported high nonunion rates may  deter  surgeons from  treating TMC OA with arthrodesis. A technique for TMC arthrodesis using the Speed™ Continuous Compression Nitinol Fixation System (BioMedical Enterprises, Inc., San Antonio, TX) and autogenous bone graft is presented here, along with outcomes of 60 consecutive patients (72 thumbs) who underwent the procedure. Subjective, clinical, and radiographic outcomes were collected and analyzed. Average patient age was 54.2 years (range, 30 to 69), and 51.7% were male. Fusion rate was 95.8% (69/72). Two of the three nonunions required revision fusion surgery. Key pinch strength increased from an average of 6.7 to 9.3 kg (P<0.05) and grip strength increased from an average of 33.7 to 41.1 kg (P<0.05) at an average follow-up of 23.4 months (median, 16.5). Patient satisfaction was 94%. Ninety percent of patients would repeat the procedure. Average postoperative Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score was 11.7 (median, 4.5) at an average follow-up of 54.2 months. Trapeziometacarpal arthrodesis using Nitinol Compression staples is a reliable  treatment option for TMC OA, with a low nonunion rate. This technique leads to excellent patient satisfaction and improved key pinch and grip strength.