Complications of trapeziometacarpal arthrodesis using plate and screw fixation

Purpose: This study,was designed to determine the complications associated,with plate and screw fixation, of thumb trapeziometacarpal arthrodesis and to compare these results with a previous report from our,instituticin';using K-wire fixation. Method: We retrospectively reviewed,26 trapeziometacarpal arthrodeses that used-plate and screw fixation. The most common diagnosis was primary. osteoarthritis and the average follow-up evaluation was,40 months. Nineteen patients were,available up examination for a clinical follow-up and radiographs. These results were compared with the previously published K-wire fixation group that consisted of 59 arthrodeses with an average follow-up period of 84 months. Results:There were 2 (8%) painful nonunions. There were 6 (23%) hardware malpositions, most frequently associated with a screw in the trapeziotrapezoid,joint. Seven (27%) arthrodeses had a second procedure, most commonly hardware removal. Twenty-one (81%) of the patients were satisfied and reported they would have arthrodesis again. In the K-wire fixation group 4 of 59 (7%) arthrodeses went on to nonunion and 2 of 59 required a secondary procedure,; patient, satisfaction was high (98%). Conclusions: K-wire and plate and screw fixation have comparable union rates. In the plate and screw fixation group, however, the satisfaction rate was lower and a second surgery was more common. We now recommend pin fixation when performing trapeziometacarpal joint arthrodesis. Copyright (C) 2003 by the American Society for Surgery of the Hand.