Thumb Arthritis: Soft-Button CMC Suspensionplasty

Thumb Arthritis: Soft-Button CMC Suspensionplasty

This video will demonstrate a surgical treatment for carpometacarpal joint thumb arthritis on a cadaveric specimen. The repair will utilize soft and hard-bodied bone anchors and flat supporting sutures suspended between 2 bones like a sling. To review the pertinent anatomy, the carpometacarpal joint, or CMC joint of the thumb, lies between the trapezium and metacarpal bone at the base of the thumb. The suture will pass through the base of the second metacarpal.

Here is a left hand. An incision has already been made overlying the top of the hand at the base of the thumb, just over the metacarpal and trapezium bones. The trapezium has already been removed to alleviate pain at this joint. A temporary metal wire will be passed through the second metacarpal's base in the void left by the trapezium's removal. The wire will help serve as the trajectory for the placement of the suture implant.

A hollow-bodied guide will be screwed over the temporary wire. This guide will further mark the trajectory of the incoming bone anchor. These lines correspond with the lines on both the drill and the anchor inserter. The metal wire is removed, and its tunnel is overdrilled. An x-ray will confirm the placement of the drill's path. Speaker1: The guide is held stable by the surgeon's assistant. The drill is removed, and the implant is advanced.

A slight tap with a mallet ensures the implant is through the base of the bone. Another x-ray is taken to confirm placement. The anchor inserter is pulled back, and the suture anchor is deployed outside the bone. The inserter and guide are removed. The surgeon checks that the anchor is firmly against the bone. The flat suture is attached to the end of the anchor and will be used as a sling for the end of the thumb's metacarpal.

A second metal wire is inserted into the base of the thumb's metacarpal. A hollow-bodied drill makes a tunnel over this wire for the second anchor. The second bone anchor is hard and has a forked-tipped end that captures the end of the flat suture. Both the anchor and the sutures will be screwed into the bone to secure the ends of the suture. Once secured in the bone, the suture ends will be trimmed. A final x-ray is shown with maintained support in motion. The incision will be closed, and the surgery will be complete.