TechniquesTreatment of Hyperextension Deformity of the Thumb Metacarpophalangeal Joint in Basal Joint Arthritis A Novel Technique Based on an Anatomic StudyZouzias, Ioannis C. MD*; Doft, Melissa A. MD†; Uzumcugil, Akin MD‡; Rosenwasser, Melvin P. MD* Author Information *Department of Orthopedic Surgery, New York Orthopaedic Hospital, Columbia College of Physicians and Surgeons †Department of Surgery; Combined Divisions of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY ‡Department of Orthopedics and Traumatology, Hacettepe University, School of Medicine, Ankara, Turkey Address correspondence and reprint requests to Melvin P. Rosenwasser, MD, Department of Orthopedic Surgery, New York Orthopaedic Hospital, Columbia College of Physicians and Surgeons, 622 West 168th Street PH 11-1130, New York, New York 10032. E-mail: [email protected]. Study is carried out in Department of Orthopedic Surgery, New York Orthopaedic Hospital, Columbia College of Physicians and Surgeons, New York, New York 10032. Techniques in Hand & Upper Extremity Surgery: June 2011 - Volume 15 - Issue 2 - p 119-124 doi: 10.1097/BTH.0b013e3182019f92 Buy Metrics Abstract Advanced stages of basal joint arthritis are sometimes characterized by an adduction deformity of the first metacarpal and a hyperextension deformity of the unstable metacarpophalangeal (MCP) joint. Stabilizing the MCP joint in these patients is critical to ensure a pain-free repair and efficient pinch mechanism. This study presents the anatomic basis for a novel capsulodesis technique using the volar plate that can be incorporated into any reconstructive basal joint procedure when clinically indicated. Eleven normal cadavers were dissected to expose the volar plate. The dimensions of the volar plate, relationship of the sesamoid bones to the oblique pulley, and the distance from the sesamoids to the base of the proximal phalanx were compared between specimens. The radial border of the volar plate measured 8.5±1.3 mm, ulnar border 8.8±1.0 mm, proximal border 7.5±1.0 mm, and distal border 7.8±0.6 mm. The distance between the ulnar sesamoid bone and the oblique pulley measured 12.1±1.1 mm and from the radial sesamoid to the oblique pulley measured 16.6±0.2 mm. The distance between the sesamoids and the base of the phalanx measured 2.2±0.2 mm. The anatomic studies provide a foundation on which the surgeon can understand the complex nature of the MCP joint. This study describes a novel technique for MCP capsulodesis of the thumb in which volar plate flaps are imbricated to provide stability to the MCP joint, obviating the need for suture anchors and tendon grafts. © 2011 Lippincott Williams & Wilkins, Inc.