Indications and techniques for thumb carpometacarpal arthrodesis

Thumb carpometacarpal arthritis is seen commonly in postmenopausal women after attenuation of the volar beak ligament. Less commonly, it may be seen in young men after an intraarticular fracture of the base of the thumb metacarpal. Although most patients respond well to nonoperative measures, two good surgical treatment options exist. Arthroplasty is performed typically in older, low-demand women, and arthrodesis is often recommended in younger patients. Recent studies have demonstrated similar outcomes with these two procedures. Thumb carpometacarpal arthrodesis is a reliable and durable treatment with very good results. It provides excellent strength, satisfactory thumb range of motion, and excellent patient satisfaction. The procedure is contraindicated in patients with arthritis in the scaphotrapeziotrapezoid joint. The surgical technique is straightforward, and fusion is usually performed with either a plate and screw construct or with multiple Kirschner wires. Although failure is rare, good salvage procedures exist. Complications are uncommon but include nonunion in approximately 13% of patients and pain related to prominent hardware.