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Journal of the Korean Society for Surgery of the Hand 1997;2(2):251-260.
Published online January 1, 1997.
Treatment of Osteoarthritis of the Trapeziometacarpal Joint
Seung Koo Rhee,Hyung Min Kim,Suk Whan Song,Hyo Seung Ahn
무지의 대능형골-중수지골간 골성관절염의 치료
이승구,김형민,송석환,안효승
Abstract
The wide range of thumb motion is derived mainly from the unusual nature of its trapezio-metacarpal (TM) joint, and an osteoarthritis is common in the joint. Over a periad of 15 years, 15 cases of osteoarthritis of TM joint were treated with ligament reconstruction using Eaton and Littler technique in 8 cases (associated with hypermobility and occasional pain), and with arthrodesis in 7 cases (associated with painful osteoarthritis). Splint was applied for 4 weeks in the case of ligament reconstruetions but for 8 weeks in the ones of arthrodesis. They were traced for average 3 years and 5 months. Among the cases of arthrodesis, there were 2 cases(2/7, 28.6%) of non-union requiring bone graft. Grip and pinch strength were less than those of normal contol by average 10% of the patients. Thumb joint motions measured on serial C-arm films showed 14% reduction in fusion group (total ROM 161') and 8% reduction in ligament reconstruction group (total ROM 172) in flexion-extension than control (total ROM 187¡Æ). However, MP joint mobility was increased in compensation to 64¡Æ in fusion group and 53¡Æ in ligament reconstruction one in comparison with that of control(52¡Æ) in flexion-extension, and to 19¡Æ in fusion group and 14 in ligament reconstruction group in comparison with that of control(12¡Æ) in abductian-adduction. Pain of TM joint was subsided markedly in fusion poup after the operation but in ligament reconstruction poup. Staging of TM joint degeneration was considered to be decide the type of treatment. Restoration of strength, mobility, and relief of pain were better if ligament reconstruction was performed before significant articular damage was noted on roentgenograms. Fusion on advanced osteoarthritis of TM joint could provide the painless and stable thumb, however the restriction of thumb motions in CMC joint and the compensatory hyperextension of MP joint as complications should be considered in mind.
 


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