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Long-term Outcomes of APL Suspensionplasty with No, Partial, or Complete Trapezoid Excision
PAPER 45 Clinical Paper Session 6 Outcomes/Thumb e Saturday, September 9, 2017 8:28e8:33 AM Treatment
Long-term Outcomes of APL Suspensionplasty with No, Partial, or Complete Trapezoid Excision Level 4 Evidence
Kevin J. Renfree, MD Ryan A. Odgers, MD Nan Zhang, MS Cody Tillinghast, BS
Figure 44-2: Articular nerve branches innervating thumb CMCJ originating from PCBMN.
COI: There is no financial information to disclose. Hypothesis: Partial or complete trapezoid excision, combined with trapeziectomy and abductor pollicis longus (APL) suspensionplasty, impacts long term radiographic and clinical results. Methods: Sixty-nine patients (79 hands) underwent surgery for basal joint arthritis. Eighty-seven percent were female with a mean age 64. The dominant hand was involved in 57%. Advanced scaphotrapezial-trapezoid arthritis was noted intraoperatively in 55%, and treated with resection of the proximal 50% of the trapezoid (PT) in 21 hands (27%), and complete trapezoid (CT) resection in 22 (28%). No trapezoid excision was required (NT) in 36 hands. Fisher’s exact tests compared categorical outcomes and linear regression investigated whether predictors of interest (PT, CT or NT) had any effect on continuous variables such as Patient Rated Wrist Evaluation (PRWE), or DASH. Results: Mean follow up was 95 months. There was no significant difference in satisfaction or the desire to have the procedure again. Mean total pain score was significantly lower with CT (4.89) and PT (4.94) when compared to NT (11.37). CT had significantly lower (better) mean total functional and usual activity scores on the PRWE, and four sub-scores on the quickDASH when compared to NT, but not to PT. Significant decreases in mean carpal height ratio (CHR) were seen in NT and CT. There was no significant difference between PT and CT; NT and PT had significantly more proximal collapse of the thumb metacarpal relative to the scaphoid compared to CT. Only NT had a significant change in the scapholunate angle. Both PT and CT had significant proximal migration of the index metacarpal. Complication rates trended higher in CT (27.3%) when compared to PT (23.8%)and NT (16.7%) but was insignificant. Secondary procedures were highest in CT (18%) and involved arthrodesis of the index and long finger carpometacarpal joints. Summary Points: Complete trapezoidectomy had the greatest decrease in CHR and radiographic collapse of the index metacarpal, but without significant change in the scapholunate angle. It had the lowest (best) total pain and functional scores on the PRWE. While CT also led to the greatest improvement in total functional scores (PRWE), the authors now only do PT for two reasons: (1) No significant differences in radiographic or clinical outcomes between PT and CT. (2) Higher complication rate with CT, notably an 18% incidence of symptomatic index CMCJ collapse and arthritis requiring arthrodesis. NT patients had the highest total pain score and this may be due to impingement between the thumb metacarpal and trapezoid.
PAPER 46 Clinical Paper Session 6 Outcomes/Thumb e Saturday, September 9, 2017 8:35e8:40 AM Treatment; Prognosis/Outcomes
LRTI Post-operative Rehabilitation Protocol: A Randomized, Prospective, Multicenter Study Comparing a Conservative Casting Regimen to an Earlier Mobilization Splinting Regimen Level 2 Evidence
Figure 44-3: Articular nerve branches innervating thumb CMCJ originating from RSN. S30
Douglas T. Hutchinson, MD Stephanie Sueoka, MPT, DPT, CHT Angela A. Wang, MD Andrew Tyser, MD
Long-term Outcomes of APL Suspensionplasty with No, Partial, or Complete Trapezoid Excision Level 4 Evidence
Kevin J. Renfree, MD Ryan A. Odgers, MD Nan Zhang, MS Cody Tillinghast, BS
Figure 44-2: Articular nerve branches innervating thumb CMCJ originating from PCBMN.
COI: There is no financial information to disclose. Hypothesis: Partial or complete trapezoid excision, combined with trapeziectomy and abductor pollicis longus (APL) suspensionplasty, impacts long term radiographic and clinical results. Methods: Sixty-nine patients (79 hands) underwent surgery for basal joint arthritis. Eighty-seven percent were female with a mean age 64. The dominant hand was involved in 57%. Advanced scaphotrapezial-trapezoid arthritis was noted intraoperatively in 55%, and treated with resection of the proximal 50% of the trapezoid (PT) in 21 hands (27%), and complete trapezoid (CT) resection in 22 (28%). No trapezoid excision was required (NT) in 36 hands. Fisher’s exact tests compared categorical outcomes and linear regression investigated whether predictors of interest (PT, CT or NT) had any effect on continuous variables such as Patient Rated Wrist Evaluation (PRWE), or DASH. Results: Mean follow up was 95 months. There was no significant difference in satisfaction or the desire to have the procedure again. Mean total pain score was significantly lower with CT (4.89) and PT (4.94) when compared to NT (11.37). CT had significantly lower (better) mean total functional and usual activity scores on the PRWE, and four sub-scores on the quickDASH when compared to NT, but not to PT. Significant decreases in mean carpal height ratio (CHR) were seen in NT and CT. There was no significant difference between PT and CT; NT and PT had significantly more proximal collapse of the thumb metacarpal relative to the scaphoid compared to CT. Only NT had a significant change in the scapholunate angle. Both PT and CT had significant proximal migration of the index metacarpal. Complication rates trended higher in CT (27.3%) when compared to PT (23.8%)and NT (16.7%) but was insignificant. Secondary procedures were highest in CT (18%) and involved arthrodesis of the index and long finger carpometacarpal joints. Summary Points: Complete trapezoidectomy had the greatest decrease in CHR and radiographic collapse of the index metacarpal, but without significant change in the scapholunate angle. It had the lowest (best) total pain and functional scores on the PRWE. While CT also led to the greatest improvement in total functional scores (PRWE), the authors now only do PT for two reasons: (1) No significant differences in radiographic or clinical outcomes between PT and CT. (2) Higher complication rate with CT, notably an 18% incidence of symptomatic index CMCJ collapse and arthritis requiring arthrodesis. NT patients had the highest total pain score and this may be due to impingement between the thumb metacarpal and trapezoid.
PAPER 46 Clinical Paper Session 6 Outcomes/Thumb e Saturday, September 9, 2017 8:35e8:40 AM Treatment; Prognosis/Outcomes
LRTI Post-operative Rehabilitation Protocol: A Randomized, Prospective, Multicenter Study Comparing a Conservative Casting Regimen to an Earlier Mobilization Splinting Regimen Level 2 Evidence
Figure 44-3: Articular nerve branches innervating thumb CMCJ originating from RSN. S30
Douglas T. Hutchinson, MD Stephanie Sueoka, MPT, DPT, CHT Angela A. Wang, MD Andrew Tyser, MD