Review Question - QID 5956

Metacarpal subsidence is present in up to 30% of cases following LRTI, however, this has not been shown to affect clinical outcomes and therefore nothing further is warranted in this case.

There are many surgical options for CMC OA. This includes volar ligament reconstruction and closing wedge dorsal extension osteotomy for early Stage I disease. Late disease is treated with trapeziectomy with/without metacarpal base stabilization, CMC fusion and prosthetic arthroplasty. There is no difference in results of trapeziectomy alone vs trapeziectomy with LRTI. Silastic arthroplasty is complicated by silicone synovitis. Pyrocarbon prosthetics are complicated by subluxation attributed to a shallow trapezial cup. Fusion is indicated for young (<50y) high demand patients who wish to maintain grip strength.

Jones et al. reviewed salvage options for FCR disruption during LRTI. For partial FCR injury, they recommend using the remaining tendon for a Weilby suspensionplasty, or the entire FCR for LRTI (if enough length is available). For complete FCR avulsion, they recommend ECRL LRTI.

Yang and Weiland followed 15 LRTIs for 32 months. Radiographs were obtained at rest and during pinch. The first metacarpal subsided in 21% at rest and an additional 11% during key pinch. Clinically, key pinch improved 17th postoperatively. There was no correlation between subsidence and clinical outcome.

Figure A shows subsidence of the thumb metacarpal after trapeziectomy.

Incorrect Answers:
Answer 1: While FCR is commonly used for suspension, it is not indicated at this time.
Answer 2: The ECRL can be used for suspension in cases when the FCR is not available, but it is not indicated in this setting.
Answer 3: While the APL has been described for suspension, it is not indicated at this time.
Answer 4: Although suture button suspension has limited supporting evidence, it although can be used as an adjunct in the treatment of basilar thumb arthritis.