Thumb Arthritis: Reconstruction With Adjustable Sutures

Thumb Arthritis: Reconstruction With Adjustable Sutures

This video will demonstrate a surgical treatment for carpometacarpal joint thumb arthritis on a cadaveric specimen. The repair will utilize suture and 2 metal suture buttons suspended between 2 bones for support.

To review the pertinent anatomy, the carpometacarpal joint, or C M C 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 thumb to the base of the index finger, also called the second metacarpal.

Here is a right hand. The first of 2 incisions will be made overlying the base of the thumb on the top of the hand. A second, smaller incision will also be made to the top of the hand, this time on the outside base of the second metacarpal. Soft tissue will be further dissected over the incision at the base of the thumb, and the surgeon will be mindful of vital nerves and vessels in this area.

The trapezium is identified at the base of the incision, and the soft tissue holding it in place will be cut in preparation for its removal. This bone is removed to help eliminate pain. A surgical instrument similar to a corkscrew will pull the bone out. Here, the surgeon is showing an x-ray of the recently removed trapezium.

The second incision is then made. The soft tissue is carefully moved to expose the base of the second metacarpal. This is important for the exit point of the wire that will soon be passed. A guide will be placed over the base of the thumb's metacarpal and second metacarpal in preparation for passing the temporary wire in this trajectory.

Once the guide is in place, the wire will be passed until it exits the base of the second metacarpal. Speaker1: The guide will be removed, and the remaining length of the wire will be drilled. An x-ray shows the trajectory of the wire through the base of the thumb's metacarpal and the second metacarpal. The wire's end is shown with a tapered end, which will help it pass through the recently created tunnel.

The very end of the wire has a loop, and the surgeon is shown threading a suture through it, so the wire can capture the suture as it is gently pulled through the tunnel. The end of this suture has a metal button, which will be pulled to the base of the thumb metacarpal. The other end of the suture will be cut, so another button can be threaded to this end.

This button is slid down the suture to the base of the second metacarpal and gently adjusted into place. The button is then tied into place with the suture ends until it is in the best position, not too tight or too loose. The surgeon assesses for movement in the thumb after the button is secured.

If the surgeon is pleased with the thumb's range of motion, additional knots will be tied to finalize the button's placement. The suture will then be trimmed. The knot and suture are tucked under the soft tissue in the hand. The capsule around the removed trapezium is closed, so it can scar and heal in place. The remaining soft tissues are sutured closed. The patient will be placed in a splint temporarily. The surgery is now complete.