Arthroplasty for Fifth Carpometacarpal Joint Arthritis

Abstract

Background Fifth-carpometacarpal (CMC)-joint fractures and dislocations can produce carpometacarpal joint arthritis. The purpose of this study was to evaluate the radiographic and clinical outcomes of arthroplasty for fifth carpometacarpal joint arthritis.

Material and Methods A series of six patients who had symptomatic advanced fifth-CMC arthritis and had failed to respond to conservative treatment. All patients underwent Dupert's technique of fifth-CMC arthroplasty with a mean follow-up of 17.6 months. Results were reviewed clinically and radiographically.

Results Union between the fourth and fifth metacarpals was observed at an average of 6.2 weeks after surgery. Grip strength improved. Range of motion (ROM) of the fifth metacarpophalangeal (MCP) joint and the fifth metacarpal height remained unchanged. Visual analog scale (VAS) results improved significantly.

Conclusion Despite the medium-term follow-up and small number of patients, our results suggest fifth-CMC arthroplasty with arthrodesis of the fourth and fifth metacarpal bases may be a reliable procedure for fifth-CMC arthritis.

Keywords

carpometacarpal joint - arthritis - arthroplasty - arthrodesis

IRB Approval

Institutional review board approval from University of Louisville was obtained for this study.

• References

• 1 Dobyns JH, Linscheid RL, Cooney III WP. Fractures and dislocations of the wrist and hand, then and now. J Hand Surg Am 1983; 8 (5 Pt 2): 687-690
• 2 Jebson PJ, Engber WD, Lange RH. Dislocation and fracture-dislocation of the carpometacarpal joints. Orthop Rev 1994; (Suppl): 19-28
• 3 Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br 1987; 69 (2) 212-214
• 4 Green WL, Kilgore Jr ES. Treatment of fifth digit carpometacarpal arthritis with Silastic prosthesis. J Hand Surg Am 1981; 6 (5) 510-514
• 5 Black DM, Watson HK, Vender MI. Arthroplasty of the ulnar carpometacarpal joints. J Hand Surg Am 1987; 12 (6) 1071-1074
• 6 Gainor BJ, Stark HH, Ashworth CR, Zemel NP, Rickard TA. Tendon arthroplasty of the fifth carpometacarpal joint for treatment of posttraumatic arthritis. J Hand Surg Am 1991; 16 (3) 520-524
• 7 Dubert T. Stabilized arthroplasty of the fifth metacarpal bone. A therapeutic proposal for the treatment of old fractures-luxations of the fifth metacarpal bone [in French]. Ann Chir Main Memb Super 1994; 13 (5) 363-365
• 8 Bain GI, Unni PM, Mehta JA, Eames MH. Arthrodesis of ring finger and little finger metacarpal bases for little finger carpometacarpal joint arthritis. J Hand Surg [Br] 2004; 29 (5) 449-452
• 9 Joseph RB, Linscheid RL, Dobyns JH, Bryan RS. Chronic sprains of the carpometacarpal joints. J Hand Surg Am 1981; 6 (2) 172-180
• 10 Nakamura K, Patterson RM, Viegas SF. The ligament and skeletal anatomy of the second through fifth carpometacarpal joints and adjacent structures. J Hand Surg Am 2001; 26 (6) 1016-1029
• 11 El-Shennawy M, Nakamura K, Patterson RM, Viegas SF. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg Am 2001; 26 (6) 1030-1035
• 12 Harwin SF, Fox JM, Sedlin ED. Volar dislocation of the bases of the second and third metacarpals. A case report. J Bone Joint Surg Am 1975; 57 (6) 849-851
• 13 Meunier MJ, Hentzen E, Ryan M, Shin AY, Lieber RL. Predicted effects of metacarpal shortening on interosseous muscle function. J Hand Surg Am 2004; 29 (4) 689-693
• 14 Jawa A, Zucchini M, Lauri G, Jupiter J. Modified step-cut osteotomy for metacarpal and phalangeal rotational deformity. J Hand Surg Am 2009; 34 (2) 335-340
• 15 Bora Jr FW, Didizian NH. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg Am 1974; 56 (7) 1459-1463