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The Addition of an Oblique Lag Screw to T-Plate Fixation Decreases Nonunion Rate in Trapeziometacarpal Arthrodesis

Pflibsen, Lacey R. MD; Noland, Shelley S. MD; Cooper, Annica L. BS; Smith, Anthony A. MD

Plastic and Reconstructive Surgery – Global Open: July 2019 - Volume 7 - Issue 7S - p 4-5
doi: 10.1097/01.GOX.0000579816.71820.43
Mountain West 2019 Abstract Supplement

Mayo Clinic Arizona, Phoenix, AZ

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: T-plate fixation is a popular method for trapeziometacarpal arthrodesis (TMA) in the osteoarthritic patient.1–6 Previous studies report 8–18% rate symptomatic nonunion, 26% rate radiographic nonunion. The addition of an oblique lag screw to T-plate fixation may compress the arthrodesis site and decrease nonunion rate.

METHODS: A retrospective review of all TMA for osteoarthritis by a single surgeon between 2010- 2018 was completed. The technique was identical in all surgical cases, utilizing an oblique lag screw across the arthrodesis site from the metacarpal to the trapezium. Postoperative nonunion rate and time to clinical healing and radiographic union were reviewed.

RESULTS: A total of 22 TMA were performed on 17 patients using the above technique. The average age was 53, 71% female, 53% involving the dominant hand. All patients preoperatively reported constant pain refractory to conservative management. Mean preoperative Eaton classification was 2.74 (± 0.73). Mean time to clinical healing was 34 days (± 12 days), and mean time to radiographic union was 55 days (± 23 days). Mean follow up was 9 months, and no patients were found to have symptomatic or radiographic nonunion. Hardware removal was required bilaterally in one patient after complete healing.

CONCLUSIONS: The addition of oblique lag screw to T-plate fixation is a novel technique in TMA. In this study, no patients were found to have symptomatic or radiographic nonunion, which is lower than other published rates utilizing other techniques.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.