Trapeziometacarpal Joint Arthrodesis Using a Locking Plate and Headless Compression Screw With an Autogenous Bone Graft.

Purpose: Trapeziometacarpal (TMC) joint arthrodesis is an established surgical option to manage TMC joint arthritis. However, nonunion remains a complication after arthrodesis. In this study, we aimed to evaluate the outcomes of using a locking plate and headless compression screw with autogenous bone grafting.

Methods: We identified 21 thumbs that underwent TMC arthrodesis using this procedure. Radiographs and computed tomography scans were obtained to define bone union. Furthermore, we asked patients whether they had returned to their original work at every follow-up visit. To assess objective and subjective outcomes, we measured grip and pinch strengths; range-of-motion; radial and palmar abduction; Kapandji score; visual analog scale score; Disabilities of the Arm, Shoulder, Hand score; and Hand20 questionnaire scores before surgery and at 3, 6, and 12 months after surgery.

Results: Bone union was achieved in all patients. Bone fusion was achieved within 8 weeks after surgery in 17 thumbs, the remaining thumbs achieved bony fusion within 11 weeks. Thirteen of the 14 patients who had paid employment returned to their original work after a mean of 7 weeks. Grip and pinch strengths decreased at 3 months but returned to baseline levels at 6 months after surgery. Metacarpophalangeal joint flexion and Kapandji score decreased at 3 months and did not recover to baseline levels at 1 year after surgery. The visual analog scale and Disabilities of the Arm, Shoulder, Hand scores, and the Hand20 questionnaire showed improvement in the early postoperative period, which continued until 1 year after surgery.

Conclusions: Locking plate and headless compression screw fixation with an autogenous bone graft allows for a reliable bone union and return to work.

Type of study/level of evidence: Therapeutic Ⅳ.